Sonographic appearance of epididymal microlithiasis

Area of Science:

• Radiology
• Urology
• Andrology

Background:

• Epididymal microlithiasis is a rare condition characterized by the presence of microcalcifications within the epididymis.
• It is distinct from testicular microlithiasis, a more common condition involving calcifications within the testicular parenchyma.

Observation:

• A 75-year-old man presented with right groin pain and an inguinal hernia, undergoing scrotal ultrasound for evaluation.
• Sonography revealed multiple, comet-shaped microcalcifications with comet-tail artifacts throughout both epididymides.
• The testicular parenchyma appeared normal, with no signs of testicular microlithiasis.

Findings:

• The case demonstrates a sonographic diagnosis of epididymal microlithiasis in a symptomatic patient.
• This presentation highlights the characteristic imaging features, including microcalcifications and comet-tail artifacts within the epididymis.
• The testes were unaffected, differentiating it from testicular microlithiasis.

Implications:

• Epididymal microlithiasis is a distinct sonographic entity that requires recognition and differentiation from other extratesticular calcifications.
• Understanding its appearance is crucial for sonographers and radiologists to avoid misdiagnosis and ensure appropriate patient management.
• The condition may be associated with aging and ischemia, as suggested by previous cadaveric studies.